2008 Examples of Excelencia Nomination Form

Nominations close May 16, 2008 at midnight EST. Questions? Call Lourdes Guerrero, Director of Programs and Communication, at 818-920-3485 or e-mail at lguerrero@edexcelencia.org.

* Designates a required field

Nominator Information

First Name:* City:*
Last Name:* State:*
Title: Zip Code:*
Institution/Organization:* Telephone:*
Street Address 1:* Email Address:*
Street Address 2:

Nominee Information

Please list the complete name of the nominated academic program, department, organization or project *

Nominated Program Information:
Please indicate the level of your nomination.*
Programs or departments must be submitted as Associate, Baccalaureate or Graduate level nominations (students served may be at mixed-levels). One program at each level will be recognized as the 2008 Examples of Excelencia.

Associate Level
Baccalaureate Level
Graduate Level

Key Personnel:
Name and contact information for key personnel in program or department. This information is essential as Excelencia staff will contact this individual for more information about the program or department.

First Name:* City:*
Last Name:* State:*
Title: Zip Code:*
Institution/Organization:* Telephone:*
Street Address 1:* Email Address:*
Street Address 2: Website:

Program Description:
Please state the mission and purpose of the nominated academic program, department, organization or project.*

Program Staff:
Please provide a brief description of the program staff and history (include organization size, years in service).*

Services:
Please state the services provided by the nominated academic program, department, organization or project (include description of services, number of students served).*

Evidence of Effectiveness:
Please provide evidence of effectiveness (i.e. quantitative and qualitative information, enrollment, persistence, graduation data).*

Additional Info:
Please attach any additional program information here
(Max file size: 256K; Accepted file formats: .DOC, .PDF)

Mailing:
Would you like to receive news about Excelencia in Education? *
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